Heart Failure, Hemodialysis Complication
Conditions
Keywords
Vericiguat, Heart failure, Hemodialysis Complication
Brief summary
Chronic Kidney Disease often requires dialysis and other treatments to sustain life, and patients frequently suffer from heart failure, which exacerbates the disease burden. Research has shown that the incidence of heart failure is high among patients on dialysis, and the prognosis is poor. In recent years, there has been significant progress in the treatment of heart failure. Vericiguat, a novel sGC stimulator, can improve cardiac function and exercise tolerance, reduce the risk of cardiovascular death and hospitalization for heart failure, and has good tolerance. It has been included in relevant guidelines as a recommended drug. It has good tolerance in patients with renal insufficiency, and its therapeutic effect is consistent in patients with different levels of eGFR. However, there is a lack of prospective, randomized controlled studies targeting the special population of patients on dialysis. This study is a prospective, observational, single-arm study, planning to recruit 118 patients from June 2025 to June 2026. It aims to assess the efficacy and safety of Vericiguat in patients with heart failure on hemodialysis, to provide new evidence-based medical evidence for the treatment of heart failure in this special population, optimize the treatment strategy, and improve the prognosis and quality of life.
Interventions
DRUGVericiguat
Under the premise of ensuring safety, treat with a stable dose of Vericiguat 2.5mg PO QD for 2 weeks. After 2 weeks, increase the dose to 5mg PO QD. If blood pressure elevation occurs during the operation phase, the researchers suggest titrating or starting additional antihypertensive drugs, with a follow-up of 12 months. If the patient has tolerability issues (symptomatic hypotension or SBP\<90 mmHg), the dose should be reduced or discontinued.
Sponsors
Guangdong Provincial People's Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* The patient is aged between 18 and 80 years * Suffering from chronic kidney disease (eGFR\<90ml/min/1.73m², by CKD-EPI formula). * They have chronic heart failure (NYHA class ≥II), with reduced ejection fraction, defined as LVEF≤50%. * Their serum potassium level has been ≤4.8 mmol/L in the past month. * For women of childbearing potential, the pregnancy test result is negative at the screening visit and they agree. * Adequate contraceptive measures are taken. * The patient's dialysis adequacy assessment has reached Kt/V \>1.2, or URR\>70%. * The study protocol is implemented after being approved by the hospital ethics committee, and all patients voluntarily participate in this study
Exclusion criteria
* Acute renal failure. * Systolic blood pressure below 90 mmHg at screening (systolic blood pressure less than 95 mmHg during interdialytic period). * Isolated right heart failure due to pulmonary disease; the primary cause of dyspnea is due to non-cardiac, non-heart failure reasons, such as acute or chronic respiratory diseases. * History of myocardial infarction or cerebrovascular event within the past 3 months. * History of angioedema. * Hemodialysis patients with dialysis frequency less than 3 times per week. * Significant laboratory abnormalities at screening that interfere with the assessment of the safety or efficacy of the study drug (e.g., serum potassium \> 5.5 mmol/L or \< 3.5 mmol/L, serum sodium \< 130 mmol/L, or alanine aminotransferase or aspartate aminotransferase \> 2 times the upper limit of the normal range). * History of kidney transplantation or planned kidney transplantation within the next 12 months. * Use of medications for pulmonary arterial hypertension, such as sildenafil, during the study period. * Known allergy to the study treatment (active substance or excipients). * Any other disease or treatment that makes the patient ineligible to participate in this study or to complete the entire planned study period (e.g., active malignancy or other diseases that limit life expectancy to less than 12 months). * Pregnant or breastfeeding during the study period, or intending to become pregnant.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Left ventricular ejection fraction (LVEF) | 12weeks | Change from baseline in left ventricular ejection fraction (LVEF) between baseline and end of study |
| Left ventricular ejection fraction(LVEF) | 12weeks | Change from baseline in left ventricular ejection fraction(LVEF)between baseline and end of study |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The ratio of mitral early diastolic blood flow peak and mitral annulus velocity (E/E') | 12 weeks | E/E' is measured as baseline and after 12 weeks follow-up. |
| N terminal proB type natriuretic peptide (NT-prpBNP) | 12 weeks | Blood samples will be collected for analysis of concentration of N terminal pro B type natriuretic pel proBNP) every 2 weeks |
| Left ventricular end diastolic volume (LVEDV) | 12 weeks | LVEDV is measured as baseline and after 12 weeks follow-up. |
| Pulmonary Artery Pressure | 12 weeks | Pulmonary Artery Pressure is measured as baseline and after 12 weeks follow-up. |
| Minnesota Heart Failure Quality of Life Questionnaire (LiHFe) | 12 weeks | Change in health status is assessed using the disease-specific Minnesota Heart Failure Quality of L Questionnaire. |
| Systolic and diastolic blood pressure | 12 weeks | Systolic and diastolic blood pressure will be measured every 2 weeks. |
| Electrocardiogram(ECG) | 12 weeks | ECG QT Interval analysis was performed at baseline and 12 weeks follow-up. |
| Estimated glomerular filtration rate(eGFR) | 12 weeks | changes in estimated glomerular filtration rate(eGFR) |
| Concentration of high-sensitivity serum troponin T | 12 weeks | Blood samples will be collected for analysis of concentration of serum troponin every 4 weeks. |
| Left atrial volume (LAV) | 12 weeks | LAVis measured as baseline and after 12 weeks follow-up. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Neprilysin | 12 weeks | The concentration of Neprilysis is measured by Human Neprilysin ELISA Kit as baseline and after 12 weeks following up |
Countries
China
Contacts
Primary ContactShuangxin Liu
Outcome results
None listed